Facts
[K.], born in 1940, is insured with Visana and suffers from chronic bronchial asthma, chronic sinusitis, and vegetative dystonia. Since 1994, she has been undergoing treatment for complaints in the temporomandibular joints. The diagnosed articular dysfunction and tendomyopathy were treated with physiotherapy and splint therapy.
In December 1996, her dentist, Dr. med. dent. C., requested Visana to approve the costs for a definitive prosthetic reconstruction of K.'s dentition. Visana denied the coverage, and [K.] filed a complaint. The Insurance Court of the Canton of Basel-City dismissed the complaint. [K.] then filed an administrative court appeal with the Federal Supreme Court.
Considerations
The Federal Supreme Court states that a distinction must be made between medical and dental treatments. The decisive factors are the starting point and the therapeutic objective of the treatment. Dental treatments generally concern the masticatory system, while medical treatments target other parts of the body or functions.
In the present case, the splint therapy served to relieve the jaw muscles and joints, which is a medical purpose. Therefore, the costs for this are…